A Health-Equity-Informed Qualitative Needs Assessment of Provider and Organizational Capacity to Serve Immigrant and Refugee Mental Health Needs in Sioux Falls, South Dakota

Introduction/Background: As the United States population continues to diversify, the need for culturally and linguistically appropriate mental health care grows increasingly urgent, particularly in areas experiencing more significant demographic changes driven by foreign-born populations. Sioux Falls, South Dakota, is one area experiencing significant increases of immigrant and refugee populations. This project aimed to examine local provider and organizational capacity to meet the mental health needs of immigrant and refugee populations and developed recommendations to inform future local efforts to implement culturally responsive care.

Methods: The capstone project utilized a qualitative single-case study design with embedded units of analysis (Yin, 2018) with the case in this study as the mental health service system in Sioux Falls, embedded within which are the individual mental health providers and organizations. Semi-structured interviews were conducted with local mental health care providers. The interview schedule was developed using the Health Equity Implementation Framework (HEIF) and in consultation with local community members. HEIF was further leveraged in the coding and analysis of the data using NVivo software.

Results: Ten participants took part in the semi-structured interview, representing several main mental health service settings in the local area. Key themes and subthemes were identified and mapped onto the HEIF framework. Self-reported provider capacity and confidence in serving immigrant and refugee populations correlated with personal background and experience rather than explicit training and education which was lacking specific to working with foreign-born populations. Participants noted prevalent language access issues across settings, organizations, and the community creating barriers and delays to care. On the community and systems level, participants expressed concern regarding the impact of the current sociopolitical environment, including increased immigration enforcement and anti-immigrant policies and rhetoric, leading to increased fear among local immigrant and refugee families and contributing to the closure of a local immigrant-serving organization and the downsizing of the local refugee resettlement agency.

Discussion: This study identified implications across levels of social work practice. Local providers would benefit from increased support, training, education, and supervision to develop competencies specific to immigrant and refugee mental health. At the mezzo level, organizations must work internally and collaboratively to ensure appropriate language access and mitigate broader economic and sociopolitical impacts at the local level. Further macro level policy and advocacy work is needed to address resource needs, eligibility issues, and regulations impacting immigrant and refugee mental health. Practice-based research is needed for the Sioux Falls community to identify and adapt evidence-based interventions to increase provider, organizational, and community capacity and readiness to meet the mental health needs of growing immigrant and refugee populations. Limitations of the study center on the small sample size, which does not fully represent professional backgrounds and settings in the local context.